title: Stent, balloon-assisted coiling and double microcatheter for treating wide-neck aneurysms in anterior cerebral circulation.
abstract: OBJECTIVE
  To investigate the clinical application of adjuvant coiling techniques in treating anterior-circulation wide-necked aneurysms.
  
  
  METHODS
  Over 4·5 years, 93 anterior-circulation wide-neck aneurysms in 81 patients were treated with different endovascular techniques: balloon-assisted, stent-assisted, and double-microcatheter coiling. Demographic, clinical, and angiographic data were reviewed retrospectively.
  
  
  RESULTS
  Of the 93 aneurysms, 45 were treated using stent, 28 using balloon, and 20 using double microcatheter. The proportion of ruptured aneurysms was significantly lower in the stent group (53·3%) than in the balloon (71·4%) or the double-microcatheter group (75%). Stent embolization was used for 61·1% of aneurysms located in the internal carotid artery, whereas aneurysms in the anterior communicating and middle cerebral arteries were mainly treated with balloon remodeling (42·9%) and double microcatheter (52·4%). The majority of aneurysms with neck ≧ 7 mm (87·5%) and all aneurysms with a dome/neck ratio < 1·0 (100%) were treated by stent-assisted coiling. For aneurysms with neck < 4 mm, the mean dome/neck ratio was 0·93 in the stent group, 1·08 in the balloon group, and 1·16 in the double-microcatheter group. Total occlusion was achieved in 21 cases (46·7%), with the rates for stent being significantly lower than for balloon (78·6%) or double microcatheter (75·0%). Clinical outcome was favorable in 73 cases (Glasgow Outcome Scale (GOS) 4-5) and fair in 4 (GOS 3), while 2 were severely disabled (GOS 2) and 2 others died (GOS 1).
  
  
  CONCLUSIONS
  Double microcatheter was better for distal aneurysms with dome/neck ratio of 1·1-1·2, while stent was better for proximal aneurysms with an extremely wide neck (≥ 7 mm) and for loudspeaker-shaped aneurysms (dome/neck ratio < 1·0) with poor vessel condition. For emergency cases, both balloon remodeling and double microcatheter are better choices than stent.
authors.affiliation: Zhejiang University, Hangzhou, China.
authors.forename: Jianwei
authors.initials: J
authors.lastname: Pan
authors.forename: Feng
authors.initials: F
authors.lastname: Xiao
authors.forename: Viktor
authors.initials: V
authors.lastname: Szeder
authors.forename: Ming
authors.initials: M
authors.lastname: Yan
authors.forename: Weijian
authors.initials: W
authors.lastname: Fan
authors.forename: Jun
authors.initials: J
authors.lastname: Gu
authors.forename: Lingna
authors.initials: L
authors.lastname: He
authors.forename: Renya
authors.initials: R
authors.lastname: Zhan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000601:surgery*; D001921:Brain / Q000098:blood supply*; D002533:Cerebral Angiography / Q000379:methods; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods; D057510:Endovascular Procedures / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000098:blood supply*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D062666:Vascular Access Devices